Fillable Driver Application Form printable pdf download

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888-SAY-VANS

DRIVER

APPLICATION FORM

NAME__________________________________________________________________________________________

Last

First

Middle

________________________________________ (________)________________________ ____________________________ _______________________

Social Security Number

Phone Number

Date of Birth

Hire Date

ADDRESS_____________________________________________________________________ _________________

Street

City

State

Zip

Number of Years

PAST 3 YEAR _________________________________________________________________ _________________

RESIDENCY

Street

City

State

Zip

Number of Years

_________________________________________________________________ _________________

Street

City

State

Zip

Number of Years

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related

matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only

if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other

persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in

discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

“I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be

contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I

have the right to:



Review information provided by current/previous employers;



Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected

information to the prospective employer; and



Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on

the accuracy of the information.”

Signature

Date

______________________________________________________________

________________________________

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best

of my knowledge.

Are there currently any felony charges against you?:

_____Yes _____No If “Yes” Date______________

Have you ever been convicted of any crime?:

_____Yes _____No If “Yes” Date______________

Have you ever been known by any name other than the one on this application?: _____Yes _____No If “Yes” print name below.

_______________________________________

Are you:______ a U.S. Citizen, ______ a Lawful Resident, or ______ otherwise authorized to work in the United States?

Driver Application Form

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